Massive Hemoptysis : Be Aware of Non-Bronchial Systemic Arterial Supply － A Case Report and Literature Review

大量咳血：不要忽視非支氣管動脈之體循環動脈—病例報告及文獻回顧

張書綸(Shu-Luen Chang) ； 趙恆勝(Heng-Sheng Chao) ； 黃建勝(Chien-Sheng Huang) ； 蘇剛正(Kang-Cheng Su)

《胸腔醫學》 33卷3期 (2018/06) Pp. 130-138

摘要

Massive hemoptysis is a life-threatening emergency. The bleeding usually originates from bronchial arteries (BAs), but may also arise from pulmonary arteries, or less frequently from non-bronchial systemic arteries (NBSAs). Bronchial artery embolization (BAE) is considered the first-line management for hemostasis; however, the high rebleeding rate remains a challenge. Bleeding from NBSAs is frequently missed, and this can lead to treatment failure. Surgical resection of the affected lung may eventually be required. We reported the case of a patient with tuberculous lung destruction in the right upper lobe (RUL), who experienced massive hemoptysis from both the BAs and an NBSA. Despite successful embolization of the BAs, bleeding recurred and led to cardiac arrest 2 days after the BAE. With the support of extracorporeal membrane oxygenation, the patient underwent an emergency lobectomy of the RUL. However, re-operative surgery was subsequently required due to rebleeding from a NBSA arising from the right subclavian artery, which was initially missed. The patient survived the critical bleeding episodes, but eventually died of recurrent pneumonia. Comprehensive imaging examinations, recognizing the imaging features and risks of recurrent bleeding, and planning appropriate treatment modalities are essential to improving the outcome in cases of massive hemoptysis.

關鍵字

bronchial arterial embolization ； massive hemoptysis ； multidetector computed tomography ； non-bronchial systemic artery

並列摘要

大量咳血是一種致命的急症。造成出血的來源主要是支氣管動脈（90%），少數會來自肺動脈（5%）或非支氣管動脈之體循環動脈。第一線止血措施通常是支氣管動脈栓塞，但再出血率仍然偏高，而手術切除病灶才是根除性的治療。源自非支氣管動脈之體循環動脈的出血經常被忽略，因而導致治療失敗。我們報導一位因陳舊性肺結核毀損的右上肺葉出血所導致大量咳血的病例，該出血之肺葉具有少見之雙重出血來源- 包括支氣管動脈及非支氣管動脈之體循環動脈。雖然該案例之急性出血在接受支氣管動脈栓塞術後暫時止血，兩天後又再次大咳血導致心跳一度停止。在葉克膜的支持之下，病患先接受了右上肺葉切除術，但隨即又因來自右鎖骨下動脈的分支動脈出血再次接受緊急手術。病患雖然撐過急性出血期，最後仍死於反覆肺炎。詳盡的影像學評估、辨識容易再出血的影像學徵象與危險因子，以及妥善計畫各種治療方式為改善預後的關鍵。

並列關鍵字

支氣管動脈栓塞 ； 大量咳血 ； 多偵測器電腦斷層 ； 非支氣管動脈之體循環動脈